i' °Psit 1.0
Date of Evaluation: . 't' . Z Building contact naive and phone:
V
•Evaluation Teain (list name and affiliation):. ..
It ' owe r ;~i~ve. . • (Environmental .Professional)
Th (HVAC/EIectrical Professioital)
(Sheet Metal Professional)
Building Address: Type of Facility (check alI that apply)
FR c.tFur Sr 7 esidential
i~rr L • j 0 Multi-use ,
Other (describe)
Number.of residential units: Number of floors:
HVAC Syste;n Types (check all that apply)
Unit ventilator(single residence unit) 9 Wall/window AC unit (single residence unit)
Fan coil unit(single residence unit) . Central ventilation systen)
• Heat pump unit (single residence unit) • Passive shaft/duct,
Other (describe)
Location of outside air intake:
Outside air intake accessible for inspection • •Y N (explain)
Part 2.0 . Checklists .
2.1 Ventilators, wall air conditioning units and window air conditioning:nits In common spaces •
Ventilation Systemldentification: _
C -c
Location• 9
Access adequate for inspection of components:
• Dust/Dirt/Debris Suspect WTC-Related Dust
System component
• Substrate Material
(sheet metal wrapped) Light Heavy
System Components (sheet metal lined) None (<1/16 inch (a 1/16 inch Present? Estimate % of total dust
• (fiberglass) , depth) depth (YIN) loading
(flexible connector)
(double walled)
Outside air intake louvers, grates • • • •
and/or screens
Outside air duct
Outside air daniper(s) .
Return air grille'
Return air plenum
Filter rack '
Filter media
Coils (evaporator)
Blower assembly •
Condensate drain pan
In-line electrical resistance strip
heaters (in supply ducts •
connected to unit ventilators) -
ire dampers ' . '
Turning vanes .
5upp y:air plenum or supply.duct .
Supply air plenum or supply duct • .
liner '
Supply air diffuser .
2.1 Ventilators, wall air conditioning units and window air conditioning units in common
spaces (coat.)
NYC-WTC 000132809
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000132809Source: NYC Law Department, mirrored locally